Overview of Clinical Rotations

PGY-1

The clinical rotations and course curriculum in the PGY-1 year foster the resident’s developing identity as a competent and caring physician, through rotations in medicine, neurology and psychiatry that offer broad clinical experience, excellent teaching, and appropriate levels of responsibility. In addition, residents begin to develop knowledge and skills in the diagnosis, management and treatment of severely disturbed and mentally ill inpatients. PGY-1 year is divided into six months of medicine and neurology, four months of adult inpatient psychiatry, and two months of rotations on the consult/liaison and ECT services. Residents take call at The University of Chicago Hospitals while on psychiatry, covering the Emergency Room and the general hospital for psychiatric emergencies, and providing supervision for emergent care issues arising on the University of Chicago inpatient psychiatry service at Mercy Hospital. Senior residents and faculty provide supervision to the on-call resident, initially on-site one-on-one back-up, and later, as the resident develops confidence and expertise, supervision by phone.

Medicine/Pediatrics and Neurology: Most residents spend three months on the inpatient general medicine service and one month on the general medicine consult service at the University of Chicago Medical Center. Residents spend two months on the Neurology service at the University of Chicago Medical Center.  Those residents who have a particular interest in child psychiatry may choose to spend part or all of their four months of medicine on the pediatrics service at The University of Chicago Comer Children’s Hospital, and may spend one month on the child neurology service there in addition to one month of adult neurology at UCMC.

Adult Psychiatry: Four of the six months of psychiatry in PGY-1 are spent on the adult inpatient psychiatry service at Northshore University Health Systems in Evanston, a large excellent community hospital with strong ties to the University of Chicago.  The patient population is economically and diagnostically varied and includes some patients receiving ECT.  Two additional months of psychiatry are spent on the consultation/liaison service, where residents provide consultation to pediatric, medical and surgical services at the University of Chicago Medical Center.

Courses: All PGY-1 residents attend the Psychiatry Summer Introductory Course designed to prepare them to cover the Psychiatry Emergency Room and Consultation services during the day and when on-call.  While on inpatient psychiatry at Northshore, residents attend a four-month long Introduction to Psychiatry course, and all residents attend courses in psychopathology and psychopharmacology at the University of Chicago.  Residents on psychiatry rotations also attend Morning Report, a review of patients seen in the emergency room and those admitted to The University of Chicago inpatient service at Mercy Hospital; Professor’s Rounds, a teaching conference directed by Department faculty; and the Consultation/Liaison-Emergency Room Case Conference.  Residents also attend Departmental Grand Rounds and the Thursday afternoon series of courses for all residents: Clinical Case Conferences, Psychopharmacology Conference, and Multicultural and Diversity Issues in Mental Health.

PGY-2

The PGY-2 year builds on the PGY-1 experiences in medicine and psychiatry, exposing residents to inpatient and outpatient psychiatric treatment in academic, public and private settings with more complex, dually diagnosed and medically complex patients. Residents spend four months on the University of Chicago adult inpatient psychiatry service at Mercy Hospital, a large inner-city community hospital close to the University of Chicago Medical Center.  Residents also spend two months on each of the following services:  the UofC Consultation/Liaison service, the University of Chicago Emergency Service, Chemical Dependency at Chicago Lakeshore Hospital, and Community Psychiatry, an outpatient rotation at Thresholds. PGY-2 residents develop skills as psychiatric educators through increased responsibility for the teaching and supervision of medical students, and through coursework and supervision on education and educational techniques. Residents take call at The University of Chicago Hospitals.

Mercy Hospital Inpatient Psychiatry: This general psychiatry unit treats acute patients with all major psychiatric disorders, as well as patients with comorbid substance abuse and dependence, and those with some comorbid medical problems. Patients come from the University community of students and faculty, from the varied communities on the South Side of Chicago and those surrounding Mercy Hospital, and from within the medical center itself.  Residents provide ECT for appropriate patients at Mercy Hospital.

Consultation/Liaison: The C/L service at The University of Chicago Hospitals provides consultation to all medical and surgical services in the general hospital. PGY-2 residents in psychiatry and neurology rotate on this service, which performs more than 700 consults per year. The CL service hosts an interdisciplinary case conference at which medicine, surgery and specialty services such as the ethics service can discuss with psychiatry particular cases around which there has been consultation.

Chemical Dependency: Residents spend five half-days for two months on the Chemical Dependency service at Chicago Lakeshore Hospital, under the direction of Dr. Martin Paisner, where patients are admitted for detoxification from a variety of substances of abuse. Residents participate in groups and individual treatment for addictions, attend AA meetings, and become familiar with detoxification protocols.

Community Psychiatry: Residents spend two months at Thresholds, one of the nation's largest non-profit providers of mental health services. Thresholds offers case management, education, job training and placement, housing, and operates Assertive Community Treatment Teams providing services to people with serious and persistent mental illness. Residents evaluate new patients and function as part of a team, providing outreach to people in the community in their homes and on the streets as well as in clinics.

Outpatients: Residents are expected to treat three outpatients per week during the PGY-2 year in weekly psychotherapy. Patients are referred from The University of Chicago student health service, as well as the outpatient clinics and inpatient units at The University of Chicago and Mercy Hospital. Residents have two hours of individual supervision, provided by faculty within the Department and at SCRS, the Student Counseling Resource Center on campus. Residents also rotate through the Continuing Care Clinic at the Univerisity of Chicago, which provides ongoing medication management, emergency drop-in services, and a large group experience for many patients with severe and persistent mental illness, serious economic and social problems, and major needs for rehabilitation services. This clinic works collaboratively with Thresholds.

Courses: Courses in the PGY-2 year are organized to solidify the resident’s understanding of phenomenology and psychopathology and to develop an understanding of approaches to psychotherapy. Residents continue to attend Morning Report and Professor’s Rounds, and continue courses in psychopathology, neurobiology, neuropsychiatry, and developmental and geriatric psychiatry. They begin psychotherapy training in supportive psychotherapy, a sequence of courses on psychodynamic psychotherapy and psychodynamic interviewing, and finish the year with an introduction to CBT (cognitive behavior therapy). Throughout the year, there is a Consultation/ER Case Conference. Additional courses address systems of care, and ethical issues in psychiatry. Residents begin to attend a three-year Research Seminar, focusing on developing critical reading skills, understanding research methodologies, and identifying a research project to pursue in the PGY-3 and PGY-4 years. Residents also attend Departmental Grand Rounds and the Thursday afternoon series of courses for all residents: Clinical Case Conference, Psychopharmacology Conference, CBT Case Conference, and Interdisciplinary Case Conference.

PGY-3

The PGY-3 year is exclusively an outpatient year. Designed to enable residents to function more independently and to follow a large number of patients longitudinally, PGY-3 provides year-long experience in the general psychiatry clinics, several half-day sessions set aside to see psychotherapy patients, and six-month rotations in subspecialty clinics. Subspecialty clinics include neuropsychiatry, geriatrics, child psychiatry, refractory psychosis, anxiety disorders, personality disorders, refractory affective disorders, and several medical/psychiatric clinics including a transplant clinic and a psycho-oncology clinic . Residents provide teaching and supervision for medical students and provide back-up for PGY-1 and PGY-2 residents who take call.

The General Clinics: Adult patients are referred to our clinics from within The University of Chicago Hospitals system, from inpatient stays on our inpatient psychiatry service, from the surrounding community of Hyde Park where students and faculty live, from the population of hospital and university employees, and from the South Side of Chicago and the greater Northern Indiana area. Problems vary from complex diagnostic issues to more common affective, anxiety and adjustment disorders. Residents are assigned to one general clinic per week, performing intakes and providing psychiatric follow-up to many patients for the PGY-3 and PGY-4 year. The clinics are designed to enable residents to pick up a large caseload of patients with varied diagnoses and treatments. Residents follow some patients in long-term psychodynamic psychotherapy, offer Cognitive Behavior Therapy to others, follow some family or couples cases, conduct a long- or short-term group, and have ample opportunity to work collaboratively with psychologists in coordinated treatment. Faculty include Dr.Judith Badner, Dr. Deborah Spitz, and Dr. Daniel Yohanna.

Specialty Clinics: Residents rotate for six months in a variety of specialty clinics:

Child Psychiatry—under the direction of our Child Psychiatry faculty, Dr. Sharon Hirsch, Dr. Woodard-Faust, Dr. Naranjan Karnik, Dr. Karam Radwan and Dr. Khalid Afzal, residents provide diagnostic assessment and treatment for patients with pervasive developmental disorders, disorders of attention, affective disorders, anxiety disorders, psychosis, and eating disorders.

Geriatrics—residents rotate through one or more geriatric clinics at The University of Chicago Hospitals, under the direction of Dr. Danielle Anderson, a geriatric psychiatrist. In addition, residents assess and treat patients in nursing homes.

Neuropsychiatry—directed by Dr. Fred Ovsiew, this clinic treats patients with complex neuropsychiatric problems including Parkinson’s Disease, epilepsy, MS, traumatic brain injury as well as conversion disorders.

Anxiety Disorders—directed by Dr. Emil Coccaro and staffed by a psychologist and psychology trainees as well as by residents, this clinic serves patients with severe anxiety disorders, obsessional disorders, panic disorders and other comorbid psychiatric problems. It offers comprehensive evaluation and neuroimaging, pharmacologic treatment, and CBT.



Medical/Psychiatry--under the direction of Dr. Marie Tobin and Dr. Michael Marcangelo, who attend on the psychiatric consultation/liaison service in the University of Chicago Hospitals, this clinic offers evaluation and follow-up to patients seen on the C/L service and other patients with comorbid medical and psychiatric problems. Residents also rotate in the Transplant clinic, led by Dr. Marcangelo, and in the Psycho-oncology clinic, led by Dr. Tobin.

Personality Disorders—directed by Dr. Royce Lee, this clinic offers assessment and treatment to complex patients with personality disorders and often comorbid affective disorders.

Refractory Affective Disorders—under the direction of Dr. Eliot Gershon, this clinic offers highly specialized treatment for patients with severe and refractory unipolar and bipolar disorders. It offers residents the opportunity to use sophisticated psychopharmacologic interventions and gain an understanding of the long-term evolution of severe affective illness.

Student Counseling Resource Center (SCRS)—under the direction of Dr. Tom Kramer, the SCRS provides emergency consultation, psychoeducation, psychotherapy and medication management for undergraduate and graduate students at The University of Chicago.

Outpatients: In addition to patients followed within the general and subspecialty clinics, residents are expected to follow ten to twelve hours of outpatients in various modalities of psychotherapy, including psychodynamic psychotherapy, supportive psychotherapy, CBT, combined pharmacologic and psychological treatment, and family therapy. Residents are expected to lead or co-lead at least one group, which may be time-limited and focused on a particular diagnostic issue or problem, or open-ended.  Residents receive two hours per week of individual supervision, and additional supervision is available for family and marital cases as well as individual cases for those who request it.

Courses: PGY-3 courses continue the psychotherapy, psychopharmacology and neuroscience sequences. Third-year residents collaborate with faculty to develop and present lectures in the psychopharmacology conference attended by all residents. A six-month neuroscience course addresses molecular biology and genetics, epidemiology, neuroanatomy and neuroimaging, and other topics. In the research sequence, residents identify a research team in the Department with whom to work, and begin to pursue a mentored research project. In the psychotherapy sequence, residents take courses in group and family therapy, attend a 6-month seminar and supervision group on cognitive behavior therapy for disorders of mood, anxiety and emotion regulation, and continue to study psychodynamic psychotherapy in a longitudinal case conference and a course in advanced psychodynamic theories at the end of the PGY-3 year. In addition, there are courses in forensic and addiction psychiatry. Residents attend Departmental Grand Rounds and the Thursday afternoon series of courses for all residents: Clinical Case Conference, Psychopharmacology Conference, CBT Case Conference and Interdisciplinary Case Conference.

PGY-4

In the PGY-4 year, residents solidify administrative and leadership skills, enlarge clinical confidence and autonomy, and focus on individual specialized areas of interest. Each resident assumes a Chief Resident position with significant administrative, supervision and teaching components. Each resident completes a research project and makes a presentation to the Department. Residents continue to follow outpatients in a variety of psychotherapeutic modalities, and may choose elective clinical experiences in specialized psychotherapies, such as group or family therapy, psychodynamic psychotherapy, or dialectical behavior therapy, to name a few. In conjunction with faculty advisors, each resident develops an individualized schedule for the fourth year that reflects the serious pursuit of particular interests. Some residents choose to focus on research, some emphasize clinical experiences, others assume increased teaching responsibility. The year is designed to allow maximum flexibility so that each resident may pursue a meaningful area in depth.

Chief Residencies: One chief resident serves as Administrative Chief resident, leading Residents’ Meeting and working closely with the Residency Training Director on administrative issues. Chief residents on the Mercy inpatient unit, the consultation/liaison service, and the emergency service at The University of Chicago Hospitals provide administrative leadership, teaching and supervision for medical students and junior residents on those services, leading case conferences and morning report and designing and teaching specialized courses. There is flexibility in each of these roles, and specific duties may be negotiated with the Program Director, based on the resident’s interests; for example, one fourth year resident devised a Chief residency in Medical Student Education, helping to redesign the psychiatry clerkship and focus on recruitment of medical students into psychiatry.

Research: Under the supervision of faculty research mentors and with the guidance of the Research Seminar led by the Chair, Dr. Emil Coccaro, each resident completes a research project in collaboration with one of several research groups in the Department. The resident presents the research to the Department in December of the PGY-4 year. With feedback and discussion following that presentation, each resident writes up the research as a publishable paper. Some residents choose to spend a large portion of the PGY-4 year on larger research projects.

Forensic Psychiatry: PGY-3 and PGY-4 residents evaluate and write up forensic cases under the direction of one of the Department’s forensic psychiatrists, Dr. Steve Dinwiddie or Dr. Daniel Yohanna.

Elective Clinics:

Refractory Affective Disorders—under the direction of Dr. Eliot Gershon, this clinic offers highly specialized treatment for patients with severe and refractory unipolar and bipolar disorders. It offers residents the opportunity to use sophisticated psychopharmacologic interventions and gain an understanding of the long-term evolution of severe affective illness.

Geriatric Clinics—residents may elect additional geriatric experience at the South Shore Clinic, which offers geriatric medical and psychiatric care in Hyde Park, close to The University of Chicago.

Student Counseling Resource Center (SCRS)—under the direction of Dr. Tom Kramer, the SCRS provides emergency consultation, psychoeducation, psychotherapy and medication management for undergraduate and graduate students at The University of Chicago.

Intensive Sequence Elective: In conjunction with a course which reviews classic psychoanalytic theory under the direction of Dr. Harry Trosman, a senior psychoanalyst, the resident treats 2-3 patients for one year in intensive (two or three times per week) psychotherapy, with supervision provided by psychoanalysts affiliated with the Chicago Institute for Psychoanalysis.

Family Institute Elective: Under the supervision of Dr. John Rolland, residents take courses and evaluate and treat families at the Family Institute in Downtown Chicago.

Other Electives: Clinical, research and educational electives are arranged individually.